Tomotherapy

Jill Matsuoka

What is Tomotherapy
Tomo means slice in Greek. So tomotherapy
is the slice by slice treatment of tumors
Combination of CT and IMRT technologies

Types of Tomotherapy
2 Types of Tomotherapy
-Serial
Ganry of machine moves around the patient and treats 2
slices. Couch then moves in increments that are barely
perceptible to the patient to treat the next 2 slices until
dose is complete.

(Curran, n.d)

Types of Tomotherapy

(FLROcenter.com)

Types of Tomotherapy
Helical
Bore of the machine
rotates around the
patient while the
table simultaneously
moves through the
machine

History
1994 - Corvus by the Nomos Corporation.
First serial tomography machine.
2002 First patient treated with helical
tomotherapy at University of Wisconsin.
Developed by Thomas Mackie, professor at
UW Madison.
(Mackie, 2006)

How does it work?

Older forms of treatment use larger beams with
limited angles and without the ability to
completely spare healthy tissue
Tomotherapy machines can deliver treatment
with
almost surgical
precision
CT imaging allows
for precise contour
of the tumor

(City of Hope, n.d.)

How does it work?

Tomotherapy uses hundreds of pencil beams
that rotate 360 around the patient in a spiral
pattern
(City of Hope, n.d.)

One radiation beam can be divided into

thousands of narrow, tiny beams called
beamlets
(Cancer Compass, n.d.)

The beamlets have varying intensity depending

on whether theyre hitting the tumor or
surrounding tissue
(Cancer Compass, n.d.)

How does it work?

These beamlets are possible through Intensity
Modulated Radiation Therapy (IMRT)
IMRT is a dynamic treatment using a
multileaf collimator
64 leaves, each 6.25 mm
leaves move at 250 cm/second to open or shut in 20
milliseconds
(Mayurasakorn, n.d., slide 3)

How does it work?

The bore rotates 1 to 6 times per minute
For treatment delivery the rotation is divided
into 51 projections
Each projection covers an arc segment of 7
(Sterzing et al., 2008, slide 24, 29)

Tomotherapy can treat multiple fields at one

time
(Memorial Care, n.d,)

Treatment
Everyday before treatment, a CT verification
film is taken
Necessary adjustments are made due to
changing tumor volume, weight loss, etc.
Field size can be up to 40 cm wide by 160 cm
in length
(Mayurasakorn, n.d., slide 2)

Treatment
The field can almost be locked onto the
target
http://cms-sp.cityofhope.org/patient_care/treatments/radiation-oncology/Pages/helicaltomotherapy.aspx

Patients use standard immobilization devices

Treatment takes just a few minutes like
regular RT treatment

Treatment
Tomotherapy can be used to treat all types of
tumors
Small to large
Confined tumors to multiple metastases
Total body irradiation

Due to the ability to contour tumors,

tomotherapy is especially effective for cancers
of the head and neck, prostate, brain, breast
and lung

Treatment
One of the main advantages of tomotherapy is
the capability to retreat areas that have
previously been irradiated
The precise treatment can distinguish between
new cancer growth and scarring.
Surrounding tissues can be spared from
further irradiation which prevents further
scarring and ulceration

Conventional vs. Tomotherapy

(Van Dyk et al., n.d., slide 13)

Conventional vs. Tomotherapy

(BJR, Fig. 3, 2009)

Conventional vs. Tomotherapy

http://www.accuray.com/pressroom/videogallery?page=1&t=18

Trials
Currently there are around 60 trials in
different phases from recruiting to completed.
The majority were for cancers surrounded by very
critical structures:
Brain, head and neck, prostate, rectal, breast

Others to assess effectiveness of retreatment

Helical tomotherapy vs. other RT treatments
(Clinicaltrails.gov)

Locations
Tomotherapy can be found in 41 States and 27
countries
Fairview Hospital, University of Minnesota
11 sites in Wisconsin

Disadvantages
Metastases if a patient has full body
metastases this type of precise treatment may
miss a rogue cell

There is some question about treating the

tumor in fractions instead of as a whole

Summary
Sparing of critical structures
Reduced side effects
More precise treatment means larger dose and
less fractions leading to decreased treatment
days
Prostate cancer can be treated in a week to 2 weeks
instead of the usual 7-9 weeks
(UCLA Health)

Being able to retreat previously irradiated

areas

References
Clinicaltrials.gov. (n.d.). Retrieved July 14, 2013, from US
National Institutes of Health website: http://clinicaltrials.gov
Curran, B. (n.d.). Intensity modulated radiation therapy using
serial tomotherapy. In The American association of physicists
in medicine. Retrieved July 11, 2013, from AAPM website:
http://www.aapm.org/meetings/03SS/Presentations/Curran.pd
f
Helical TomoTherapy. (n.d.). In City of Hope. Retrieved July
13, 2013, from City of Hope website: http://cmssp.cityofhope.org/patient_care/treatments/radiationoncology/Pages/helical-tomotherapy.aspx

References
Mayurasakorn, S. The external beam radiotherapy and imageguided radiotherapy [PowerPoint slides]. Retrieved July 15,
2013 from http://www.docs.google.com
Mackie, T. (2006). History of tomotherapy. Physics in
Medicine and Biology, 51(13), 427-453. doi:10.1088/00319155/51/13/R54
Sterzing, Schubert, Sroka-Perez, & Herfarth. (2008, January
11). Helical tomotherapy [PowerPoint slides]. Retrieved July
3, 2013 from http://www.slideshare.net/santam/helicaltomotherapy

References
Tomita, N., Kodaira, T., Tachibana, H., Nakamura, T.,
Nakahara, R., Inokuchi, H., & Takada, A. (2009, April 14). A
comparison of radiation treatment plans using IMRT with
helical tomotherapy and 3D conformal radiotherapy for nasal
natural killer/T-cell lymphoma. In British journal of radiology.
doi:10.1259/bjr/83758373
The TomoTherapy system vs. conventional linacs. (n.d.). In
Accuray. Retrieved July 5, 2013, from Accuray Incorporated
website: http://www.accuray.com/pressroom/videogallery?page=1&t=18

References
Tomotherapy. (n.d.). In Your guide to cancer care. Retrieved
June 30, 2013, from Cancer Compass; Cancer Treatment
Centers of America website:
http://www.cancercompass.com/cancer-guide/conventionaltreatment/tomotherapy.html
TomoTherapy. (n.d.). In MemorialCare health system.
Retrieved June 30, 2013, from Memorial Care Health System
website:
http://www.memorialcare.org/medical_services/cancercare/tomo-therapy.cfm

References
TomoTherapy: accurate treatment with fewer side effects.
(2013, January 10). In UCLA health. Retrieved June 29, 2013,
from UCLA Health website:
http://www.uclahealth.org/body.cfm?xyzpdqabc=0&id=502&a
ction=detail&ref=1146&start=2&issueref=36
Van Dyk, J., Kron, T., Bauman, G., & Battista, J. (n.d.).
Tomotherapy: a "revolution" in radiation therapy. In London
health sciences center. Retrieved June 29, 2013, from London
Health Sciences website:
http://www.lhsc.on.ca/Research_Training/LRCP/Research_Sci
entists/Tomotherapy.pdf